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Skip to 0 minutes and 12 seconds PAUL SPIEGEL: Most refugees and many IDPs are outside of camps. We’re working now with a serious situation in middle income countries. So a different demographic and epidemiological disease profile, particularly non-communicable diseases. And so I think there three or four recommendations. Number one is to avoid parallel health systems. I think in the past for various reasons, refugees were in camps in very remote settings, where there was not a properly functioning national system. If we can avoid camps, we can integrate refugees into health systems. We should be able to improve the health system both for the refugees and the nationals, which would be very important. But furthermore, refugees need a means to pay.

Skip to 1 minute and 2 seconds We need to work with refugees and with the national governments to ensure that livelihoods, that refugees can actually work. There’s concern about job competition. But the World Bank is becoming more and more active in undertaking studies, both in Turkey and Lebanon and East Africa, to show that while it’s nuanced, the refugees often have at least at a local level, a positive impact in the economy. So one would be this integration and avoiding parallel services.

Skip to 1 minute and 31 seconds Also, another area to think about is to look at the country’s development plans, so that we can actually build upon, even if it’s going to be fast-tracking their development plan, so that where they’re placed or the internally displaced people where they’re placed we can build schools, health care centres, markets that will benefit the national community in the long run, as per the planning, but perhaps sped up. Another area I think that’s really important is cash-based transfers or cash-based interventions. It’s been around for a while, but in the Syria situation now, it has really escalated in a positive manner. And particularly, there are vouchers for food and food stuffs.

Skip to 2 minutes and 17 seconds But what’s really interesting is unconditional or multipurpose cash, where we’re giving care to affected populations. And they spend according to what they need. There has to be a proper market assessment, which is needed because obviously, the supply and demand have to adjust to each other. And they have to be careful. One has to be careful about inflation. But that will have a major effect on how the United Nations and the international NGOs respond in the future. It also should have a positive effect on the local economy, because refugees or IDPs are spending in those areas. And it provides dignity to them they have choice, and it increases sustainability and reduces dependency.

Skip to 3 minutes and 3 seconds The one caveat is that for education and for health, it’s not the same as for non-food items or food items, because you need an infrastructure. You need properly-trained cadre of professionals. If they don’t exist, then you can give all the money in the world, but they may not be able to receive sufficient care, which leads us to issues related to research and data.

Skip to 3 minutes and 27 seconds MARCUS GEISSER: I think we have failed to understand the absolute importance of local responders. I think in any given crisis– not only in a natural disaster, if you think of tsunamis, if you think of an earthquake, if you think of natural disasters– very often, also in times of conflict, actually it’s the locals on the grounds that are there, and who actually act first. And it’s actually quite bizarre, because if you think of the history of the organisations that I represent, International Committee of the Red Cross, Henry Dunant came across thousands of wounded soldiers on the battlefield of Solferino in Italy. It was not him, a loner Geneva-based businessman travelling to Italy who responded to help thousands of wounded soldiers.

Skip to 4 minutes and 20 seconds It was actually first and foremost nuns of a local monastery. And I think we seem to have forgotten over the years, as the international humanitarian aid apparatus developed, actually, the level of the local responders. I think there’s a recognition now that they’re absolutely important. I mean, this has been widely discussed in the World Humanitarian Summit. It is absolutely correct. It is also one particular instrument that many donors, but also international organisations have signed up to. It’s called the Grand Bargain, that actually would imply to those who have signed it up, and to hopefully take responsibility seriously that they actually assist directly local humanitarian actors much more.

Skip to 5 minutes and 8 seconds To come back to your questions about how humanitarian aid organisations should preserve the modern realities of today’s emergencies, I think what we also need to recognise that if you think of one indicator of how indeed protracted conflicts are of how much conflict is out there and how much violence, I think the figures of those people who have been forcibly displaced due to a war are probably the best indicator of how bad things actually are. According to UNHCR figures– I think they are UNHCR figures– today in 2016, we count 65 million people who have been involuntarily, forcibly displaced. Out of those 65 million, you have I think, over 20 million refugees.

Skip to 5 minutes and 56 seconds But all the other 40 or so, they are internally displaced people. And I would say that as much as it is absolutely necessary to have an international refugee law, for example, it’s absolutely essential. And it should not be eroded of course. We also need to recognise that at times, the level of attention for IDPs has been slipping away. And I think we need to make sure that we again remind ourselves of the plight of internally displaced people, who very often– if you think of Syria for example, if you think of Afghanistan, if you talk to IDPs there– they have displaced internally in their given context, numerous times, sometimes dozens of times.

Skip to 6 minutes and 43 seconds And I think it would be very shocking if the international community, but also international aid organisations would not actually double-up their efforts to assist IDPs.

What will humanitarianism look like in the future?

We cannot know for certain, but how will humanitarianism change in practical terms given what we know from recent events?

In the video we hear from two experts, Paul Spiegel from Johns Hopkins University and Markus Geisser from the International Committee of the Red Cross and Red Crescent (ICRC), learning about how they think humanitarianism will evolve. They touch upon the importance of local actors, cash-based transfers, and recognising and providing adequate services for internally displaced peoples.

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Health in Humanitarian Crises

London School of Hygiene & Tropical Medicine